EMILY MARTIN

HISTORIES OF IMMUNE SYSTEMS

The practices and concepts that pertain to the human body often provide singularly telling clues about the nature of power in different historical and

cultural contexts. For example, in the Classical age, as Foucault describes it, power was exerted by the sovereign through repressive legal codes and the force of the state apparatus. Punishment was wrought on the very body of the criminal as in the opening scenes of Discipline and Punish where a prisoner's body is

slowly pulled to pieces by teams of horses (Foucault 1979). In contrast, with the

coming of modern power, gossamer microcontrols that hold the body in time

and space arise in a multitude of contexts: prisons, hospitals, schools, the

military, the factory. Docile bodies are produced through the gaze of the prison

managers in the Panopticon, or the disciplinary gaze and questions of the therapist, doctor, sociologist, or demographer.

Modern power, biopolitics, arose together with, or as Foucault puts it, consubstantial with, changes in the economy and polity involved in the rise of the self-affirmation of the bourgeoisie. As the bourgeoisie came into its own, its self definition was based in part on knowledge of the populations of the nation states of which it was the core: their size, rate of growth, health, composition. The inherited "pure" blood of the aristocracy of the classical era gave way to the

"normal" healthy blood, body, brains, and brawn of the bourgeoisie (Foucault 1980A: 125-26).

The process of normalization lies at the heart of how modern power operates: the "normalizing gaze...establishes over individuals a visibility through which one differentiates them and judges them" (Foucault 1979:184).

Our norms are always on the move as if their goal was to bring every aspect of our practices together into a coherent whole. To this end various experiences are identified and annexed as appropriate domains for theoretical study and intervention. Within all these domains, the norms do not rest but, at least in principle, are endlessly ramified down to the finest details of the micropractices, so no action that counts as important and real falls outside the grid of normality. In addition, as in normal science, the normalizing practices of bio-power define the normal in advance and then proceed to isolate and deal with anomalies given that definition. [Dreyfus and Rabinow 1983:258]

Foucault is at pains to explain why it is so hard for us to see the nature of modern power, especially why we continue to think of power as if it were repressive, in the Classical mode, what he calls its "emaciated form" (1980A:86), rather than "productive" as it is in its modern form. The reason he ventures is that "power is tolerable only on condition that it mask a substantial part of itself. Its success is proportional to its ability to hide its own

Culture, Medicine and Psychiatry 17: 67-76, 1993. �9 1993 Kluwer Academic Publishers. Printed in the Netherlands.

68 EMILY MARTIN

mechanisms" (p. 86). If Foucault's suggestion for why we fail to recognize the nature of modem

power is at all plausible, then another question immediately presents itself: might there be ways, from the vantage point of the 1990s instead of the 1970s when Foucault wrote these analyses, why we now, having learned our Foucaul-

dian lesson, think of everything as if it were an instance of modem power when, within it, another quite different form of power is arising?

This thought is given force by Foucault's notion that kinds of power arise

consubstantially with important shifts in the nature of the economy and the policy. In an interview with Jean-Pierre Barou and Michelle Perrot, Perrot says

to Foucault:

You are opposed to the idea of power as a super-structure, but not to the idea that power is in some sense consubstantial with the development of forces of production, that it forms part of them.

Foucault replies:

Absolutely. And power is constantly being transformed along with them. The Panopticon was at once a programme and a utopia, but the theme of a spatialising, observing, immobilizing, in a word disciplinary power was in fact already in Bentham's day being transcended by other and much more subtle mechanisms for the regulation of phenomena of population, controlling their fluctuations and compensating their irregularities. (1980B: 159-60]

Many political economists are trying to describe a major shift in the forces of

production which was beginning to take place at the time of the publication of

Foucault's work. This shift, associated with late capitalism, is often termed

flexible accumulation (Harvey 1989:155). The hallmarks of flexible accumula- tion are technological innovation, specificity, and rapid, flexible change. It

entails: "flexible system production with [an] emphasis upon problem solving,

rapid and often highly specialized responses, and adaptability of skills to special purposes"; "an increasing capacity to manufacture a variety of goods cheaply in

small batches" (Harvey 1989:155); "an acceleration in the pace of product innovation together with the exploration of highly specialized and small-scale market niches...and new organizational forms (such as the 'just-in-time' inventory-flows delivery system, which cuts down radically on stocks required

to keep production flow going)" (p. 156). Laborers experience a speed-up in the processes of labor and an intensifica-

tion in the de-skilling and re-skilling that is constantly required. New tech- nologies in production reduce turnover time dramatically and this entails similar accelerations in exchange and consumption. "Improved systems of communica- tion and information flow, coupled with rationalizations in techniques of distribution (packaging, inventory control, containerization, market feed-back, etc.) make it possible to circulate commodities through the market system with greater speed" (p. 285). Time and space compression occur, as time horizons of

HISTORIES OF IMMUNE SYSTEMS 69

decision making shrink and instantaneous communications and cheaper transport costs allow decisions to be effected over a global space (Harvey 1989:147). Multinational capital operates in a globally integrated environment: ideally, capital flows unimpeded across all borders, all points are connected by instantaneous communications, and products are made as needed for the momentary and continuously changing market.1

What Foucault says about a "consubstantial" relationship between forms of power and forms of the forces of production leaves undetermined the meaning of "consubstantial." Other writers, for example, Jameson (1984) and Harvey (1989), have suggested a variety of ways of understanding how the social formation of late capitalism can relate to "culture" - such things as architecture, art, or literature. According to Jameson, postmodern forms reveal the "cultural logic" of late capitalism; they are the "internal and superstructural expression of a whole new wave of American military and economic domination throughout the world" (p. 57); they instantiate a "cultural dominant," a "new systemic cultural norm," a "dominant cultural logic or hegemonic norm" (p. 57). They are a "figuration of...the whole world system of present-day multinational capitalism" (p. 79). They are an approach to a representation of a new reality, a peculiar new form of realism, a kind of mimesis of reality (p. 88). For Harvey these forms are also mimetic, "In the last instance" they are produced by the experience of time-space compression, itself the product of processes in flexible accumulation (p. 344).

In this paper I make no assumption that the economic realm is so simply determinant of cultural forms. Rather, I will adopt the tactic of moving back and forth between descriptions of "cultural" and "political economic" realms, allowing them, for the interim, to have putative autonomy. 2 Without being able to solve in this context the precise causal nature of their connection, I simply want to raise the question: what might be the next step in the historical develop- ment of the body and kinds of powers regulating it that would come into existence along with a dramatic shift in political economic organization such as that being brought about by flexible accumulation? What changes in our bodies might be necessary for such a shift to occur? Perhaps docile bodies held in minutely controlled time and space by the disciplinary gaze have more to do with the dominance of total institutions and mass production systems characteris- tic of the early to mid 20th century. One might well ask, what will be next?

Thinking about this question impelled me to try to understand puzzling things I observed in two different settings in my recent research. 3 Like many ethnog- raphers attempting to do anthropological research in the complex social processes occurring today, my fieldwork has changed to contend with the "fragmentary social relations, mixed-up but not interlinked culture" of the present (Fox 1991:5). Rather than focus on a bounded setting of any kind, I have

70 EMILY MARTIN

deliberately sought out a series of disparate settings in which modal concepts of bodily health are of concern. Here I discuss patterns that emerged in two of

these settings, in which I wondered whether similar, and startlingly new, body percepts were emerging. In the first setting I wondered why, for an entire semester of weekly "Grand Rounds" at the university department of immunol-

ogy and infectious diseases where I have been doing fieldwork, every patient

presented has been black, female, elderly, very young, foreign, or working class? In the second setting I wondered why many corporations in the U.S. have

begun to invest large amounts of money in "experiential learning" on the

"Outward Bound" model for their employees, from production workers to managers. Although these two settings are not in any way institutionally

connected, I will argue that similar concepts and practices related to emerging

new body percepts are emerging in each. Let me begin with immunology Grand Rounds. Grand Rounds are held in a

teaching auditorium filled with medical students, faculty, researchers and

clinicians meeting at an early hour of the morning once a week. Small teams of doctors, students and technicians unravel the mystery of each case in stages:

from complaints the patient mentioned when admitted to the hospital, to X rays, CAT scans, or slides of microscopic enlargements of tissue.

These are histories of patients all of whom have "compromised" immune

systems, or whose immune systems have been breached by an infectious organism. In addition, all the patients presented during the semester belong to social categories that contrast by age, race, gender or class with the core cultural

identity of the white, middle class, male medical doctor in the vigor of adul-

thood. This is true even though the room holds female doctors and medical

students, and one Afro-American resident. One week, for example, the cases

presented were a one month old black male, a 64 year old white woman, a 59

year old Egyptian male, and a 56 year old white male construction worker. 4 In the context of the medical setting, Grand Rounds, doctors take these cases

to be individual disease histories. As an ethnographer, my task is to look beyond this immediate context, to ask whether central themes in these histories might be illuminated by themes in different, and longer histories. First consider the history told by immunologists about their discipline. Take, for example, the recent definitive history of the discipline, A History of Immunology, by Arthur Silverstein (1989). The story of immunology is the story of several transitions. The first one is the transition from "passive" to "active" theories. In passive theories the pathogen is seen as acting by itself to produce immunity in an otherwise inert host (p. 18). Until around the turn of the century, almost all theories were passive theories. Then with the discovery of antibodies in the 1890s, there was a transition to active theories involving host response.

The second transition is from instruction theories of how antibodies are formed to selection theories. Instruction theories, which came into vogue after

HISTORIES OF IMMUNE SYSTEMS 71

the large number of antibodies in the blood was recognized, held that the body learned how to manufacture new forms of antibodies from new kinds of foreign material (antigens) it came into contact with. After the second World War selection theories came into precedence to account for the large number of antibodies known to be present which could not be accounted for by any known exposure to existing antigens (p. 77). (One immunology lecturer I heard was fond of saying that we even have antibodies specific to antigens that would only be found on Mars.) The mechanism posited to account for their presence was genetic mutation and selection. Antibodies were capable of an extraordinary amount of mutation; certain mechanisms select the antibodies useful to the body.

The third transition involves the increasing importance of the concept of immunological specificity, which came to the fore after 1970, and which forms the central two chapters in Silverstein's book. The nature of the flexible specificity of the immune system can be simply illustrated by an experimental technique: you can oblate the immune system of a mouse by radiation and then inject human bone marrow cells into it. (Bone marrow cells are the precursors of all immune system cells.) In the mouse body, the human cells will develop into a competent and entirely functional immune system for the mouse!

What we are seeing is the emergence, as the immunologists see it, of a body which actively relates to the world, which actively selects from a cornucopia of continually produced new antibodies that keep the body healthy and enable it to meet every new challenge. Agile response, flexible specificity, adroit, supple, nimble innovative bodies poised to meet any conceivable challenge.

Is this the docile body held in place by the micro-physics of power in total institutions and mass production factory systems? Or is it the agile, anticipatory body, called into being in mutual association, constitutive relation, to a new wrinkle in the economic order, one that calls for perpetual innovation, flexible accumulation, frequent retraining, and geographical mobility on a global basis?

To see whether there is anything new about the agile, flexible, but specific body, it would be helpful to understand what everyday understandings of the body might have been like in the first half of the century in the U.S., when the production of docile rather than agile bodies would have been in full force in such contexts as mass production factories. My sources for this are popular health manuals and home health books from the 1920s to the 60s and a question- naire given to a large national sample in the 1950s by the National Opinion Research Center for which the original forms with replies recorded in long-hand, still survive in the NORC archives in Chicago. In examining this material, I have looked for central metaphors that appear in written texts, interviews, and in visual images dealing with the nature of health and how to achieve it.

In the earlier part of this century, the most important threats to health were considered to lie in the environment outside the body. Enormous attention was devoted to hygiene, cleaning surfaces in the home, clothing, surfaces of the body

72 EMILY MARTIN

and wounds with antiseptics. The most important defense is preventing entrance of germs into the body (Clark and Cumley 1953:103). An illustration from an

article in Life on polio in 1955 shows the body as a seamless whole, besieged on its surface by germs of all sorts, some drilling away with drill bits, and some

slain and marked by the victory flags of effective vaccines (Coughlan

1955:122-23 ). Images of the body as a machine abound. "An optimistic view of life...acts on

the body like oil on the working of machinery...it prevents friction" (Peabody

and Hunt 1933:374). The body's efficiency is measured and compared to that of

industrial machines (Clark and Cumley 1953:69). The "supreme importance" of regular, predictable habits is stressed (Peabody and Hunt 1933:621), good habits of personal hygiene, as well as the good habits learned by cells to produce

antibodies (according to the instruction theory then in vogue) (Clendening

1930:351). As time goes on, attention to these matters decreases in proportion to attention

to the defenses within the body. In books written in the 1960s and 1970s, there are elaborate accounts of safeguards within the body, a series of defenses within

us that are arranged in depth like the successive lines of an army (Our Human Body 1962; Miller and Goode 1960). As the interior is elaborated, and enhanced

with activity and responsiveness, concern with hygiene, the cleanliness of the

outside and surfaces of the body diminishes. It is as if, whatever is out there, and however deadly and dirty it is, the body's interior lines of defense will be able to handle it. (This, of course, was before HIV.)

By the time we reach accounts in contemporary biology and health books, the interior of the body has been enormously elaborated. "Recognition" is fantasti-

cally honed and refined and the immune system "tailors" highly specific

responses that can be almost unimaginably various. Drawing on an immense genetically generated and constantly changing arsenal of resources, the body can hardly rely on habit any longer.

To return to Grand Rounds, we can now see there both familiar aspects of modern power, in particular normalization, and the possible emergence of new kinds of power. Let me look first at the process of normalization that is going on

there. As I mentioned, the cases presented in grand rounds are those, marked by class, race, gender or age, which are insufficiently agile when faced with a new pathogen or insufficiently able to make the fine discriminations necessary to

decide which organisms must be attacked and which left alone. For example, the 65 year old construction worker, we are told right away, had occasion to use a

jack hammer on the job. He presented with a spiking night fever and an abdominal mass. The case was very mysterious, and none of the possible diagnoses of tumors or infections fit both the symptoms and the findings from blood and urine analysis. No one could come up with the right answer. So we moved on to the second stage, in which we were shown slides from pathology.

HISTORIES OF IMMUNE SYSTEMS 73

At the microscopic level we could see that the abdominal mass was made up of

huge, clear fat cells surrounded by a lot of inflammation and white blood cells,

indicating the fat cells themselves were the object of attack by the man's immune system. The light dawned on everyone in the room all at once: "You mean the jack hammer hitting his big paunch caused trauma to the fat cells and set off an autoimmune reaction?!?" one resident exclaimed. The construction

worker had a rare condition called panniculitis in which the body attacks its own fat cells.

In the midst of the general laughter that accompanied this realization, I sat

there musing another kind of construction work, namely the construction of

working class bodies as fat, unfit, crude, self-destructive, with inept immune

systems. Whether working class, female, elderly, or of color, the bodies

presented are not up to par: they fail when challenged, they have inadequately flexible responses, or inadequately specific ones. We are seeing here the process

of creation of a norm focussed on a healthy immune system, in which some individuals have healthier ones than other individuals.

To see the outlines of what might be a different kind of power, I return to the

experiential learning now being deployed on a massive scale in U.S. industry. During the learning sessions in a major corporation I will call Chem Co., teams of employees, managers as well as workers, engaged in day-long physical

challenges on special sites in rural settings. Safely protected by mountain

climbing ropes and harnesses, teams of men and women workers and managers

of all ages and physiques (as well as one of my graduate students, Karen-Sue

Taussig, and I) climbed 40 foot towers and leapt off into space on a zipline, climbed vertical 40 foot high walls and rappelled down again, climbed a 25 foot high telephone pole, which wobbled, stood up on a 12" platform at the top,

which swiveled, turned around 180 degrees and again leapt off into space. (This last is privately called the "pamper pole" by the experiential learning staff because people so often defecate in their pants while trying to stand up on it.)

According to the corporation, this is called "empowered learning." It is necessary because "We are facing an unprecedented challenge. The world is

changing faster than ever before. Our markets are becoming more complex; our

products are changing; and we are facing global competition on a scale never

before imagined" (company brochure). "Our survival in the 90s depends upon our ability to change our ways of doing things." Success in the 90s, "going over the wall" will require "letting go of old patterns and behaviors...taking a leap through difficult transitions and working hard at new beginnings"; "looking forward to change as a challenge, taking risks and innovating" (company brochure).

The bodily experiences of fear and excitement deliberately aroused on the zipline and the pole are meant to serve as models for what workers will feel in unpredictable work situations. A participant said, "If we could capture the type

74 EMILY MARTIN

of energy we experienced on the tower, at work, there'd be no limit to what we could do."

In Michel Foucault, Hubert Dreyfus and Paul Rabinow ask "Whether there might be in our future, paradigms which function in such a way as to focus important concerns for the culture, without preordaining, in a normalizing way,

what responses would count as appropriate" (1983:198). This may be the key to

what is being wrought with the bodies of workers in empowered learning. For the nature of the responses required of them cannot be specified in advance. It

would seem, then, that something other than normalization must be at work,

since the heart of normalization is to define the normal in advance. In the current picture of the creative and responsive immune system and in

empowered learning we may be glimpsing the outlines of an emerging lithe and agile body coming into being consubstantially with complex processes involved in the current stage of capitalist development. Surveillance, discipline in time

and space and a technology of normalization are the hallmarks of the power that produced docile bodies. It is unlikely that these techniques will disappear. But we are also seeing leaps into unknown empty space, relinquishment of

managerial control in return for access to the mind and body of the worker, and

an internal immune system constantly innovating and selecting, poised to meet

any possible challenge: all these are harnessed to the continual breaking of old

paradigms and habits, and they may be the hallmarks of a new dimension in the

exercise of power. The bleakest consequence of these new models of the ideal body would be

that, yet again, certain categories of people - women, people of color - will be found wanting. Like the people presented at Grand Rounds, certain social groups may be seen as having rigid or unresponsive immune systems, which

would make them unfit for the kind of work force now desired. It remains for further research to tell us whether the emergence of the flexible, agile, innovat-

ing worker will simply entrench existing lines of discrimination among people,

or give rise to new ones altogether.

Department of Anthropology The Johns Hopkins University Baltimore, Maryland 21218 U.S.A.

ACKNOWLEDGEMENTS

This paper was prepared for the 1990 meetings of the Association for American Anthropology, for the session organized by Deborah Heath and Paul Rabinow: "Biopolitics: The Anthropology of the New Genetics and Immunology." I thank

HISTORIES OF IMMUNE SYSTEMS 75

the organizers, participants, and discussant, Sharon Traweek, for a stimulating

session. I also thank the anonymous readers and Deborah Heath for useful

editorial advice.

NOTES

1 See Piore and Sabel 1984 for a different analysis of the relationship between the global division of labor and flexible specialization. 2 My earlier work assumed a rather straightforward causal connection between models of production in society and models of production in the body (1987). 3 The research is funded by the Spencer Foundation. The fieldwork involves participant observation in a university department of immunology, an immunology research lab, several urban neighborhoods, several community organizations dedicated to the AIDS crisis, an AIDS hospice and the AIDS ward of an inner city nursing home. The argument below draws on a limited segment of the ongoing research. 4 I am also investigating a context in which the people with compromised immune systems are generally part of the same social world as that of the doctors: an allergy and asthma clinic.

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